(2020) Beyond Money: Conscientious Objection in Medicine as a Conflict of Interest

Alberto Giubilini & Julian Savulescu

Journal of Bioethical Inquiry, Vol 17, pgs 229–243 (May 2020)


Conflict of interests (COIs) in medicine are typically taken to be financial in nature: it is often assumed that a COI occurs when a healthcare practitioner’s financial interest conflicts with patients’ interests, public health interests, or professional obligations more generally. Even when non-financial COIs are acknowledged, ethical concerns are almost exclusively reserved for financial COIs. However, the notion of “interests” cannot be reduced to its financial component. Individuals in general, and medical professionals in particular, have different types of interests, many of which are non-financial in nature but can still conflict with professional obligations. The debate about healthcare delivery has largely overlooked this broader notion of interests. Here, we will focus on health practitioners’ moral or religious values as particular types of personal interests involved in healthcare delivery that can generate COIs and on conscientious objection in healthcare as the expression of a particular type of COI. We argue that, in the healthcare context, the COIs generated by interests of conscience can be as ethically problematic, and therefore should be treated in the same way, as financial COIs.

Relevant Excerpt (from Conclusion)

If we frame conscientious objection as the expression of a conflict of interest in health care, then it is apparent how at the moment conscientious objection is treated and managed differently from the way other conflicts of interest are treated, and for no apparent good reason. Allowing conscientious objection to certain practices means not only acknowledging that a conflict of interest exists (because we are acknowledging that the health care professional has personal goals and motivations that conflict with professional obligations) and that the conflict is ethically impermissible (because we are acknowledging the professional’s personal goals and motivations prevent them from fulfilling their professional obligations). It also means allowing the conflict of interest to take place and to affect professional conduct when we do not allow the same to happen in the case of FCOIs. This differential treatment is not ethically justified, or so we have argued.

Source: Journal of Bioethical Inquiry (open access)